WHAT DO U KNOW ABOUT STIS?

WHAT DO U KNOW ABOUT STIS? Rattiya Techakajornkeart MD. Bangrak STIs Cluster, Bureau of AIDS, TB and STIs, Department of Disease Control, MOPH, Thailand

SEXUALLY TRANSMITTED INFECTIONS?

STIs Infections are commonly spread by sex, especially vaginal intercourse, anal sex, neovagina intercourse, oral sex and skin to skin contact. Most STIs initially do not cause symptoms.

STDs The infections are commonly /have a high probability of being spread from person to person through sexual contact. STIs The infections may not cause any symptoms. Silent epidemic Increase risk of HIV 3-5 times

STIS SITUATION

Global STIs situation

Global STIs situation http://www.empireo.es/en/enfermedadestransmisionsexual/

Thailand STIs situation

Syphilis Gonorrhea NGU Chancroid LGV

Reported total cases of STIs per 100,000 population by disease,thailand,2010-2015 (B.E.2553-2558) 23.24 2553 2554 2555 2556 2557 2558

Reported total cases of STIs per 100,000 population by disease,thailand,2010-2015 (B.E.2553-2558) 23.24 2553 2554 2555 2556 2557 2558

CAUSES?

Causes of STIs More than 30 different bacteria, viruses, and parasites can cause STIs. Bacteria e.g. chlamydia, gonorrhea, and syphilis Virus e.g. herpes, HIV/AIDS, and genital warts Parasite e.g. trichomoniasis

SYPHILIS

Caused :Treponema pallidum A Gram-negative, thin, motile, spiral shaped bacterium in the order Spirochaetales. Incubation period ~3 wk ( 10 90 days ) Transmission mode 1. Sexual contact with infected lesion or body fluid (most common) 2. Tranplacenta (less common) 3. Blood tranfusion (rare)

Manifestations of syphilis Syphilis has 3 distinct stages Primary syphilis Secondary syphilis -Latent stages Early latent syphilis Late latent syphilis Tertiary Syphilis

Primary syphilis ( Hard chancre and regional lymphadenitis ) Principal lesion = Hard chancre o Syphilitic chancres are indurated o Painless o Highly infectious o Occur anywhere on the body o Heal in 3-6 weeks.

Secondary syphilis - Begin 6-8 weeks after the appearance of the initial chancre - There is a high bacteremia during secondary syphilis alopecia

Secondary syphilis

Secondary syphilis Condyloma lata

Latent syphilis - Detectable by abnormal serologic test results - Asymtomatic Definition: persons with serological evidence for syphilis who have never received treatment for this disease and who have no clinical manifestations are said to have latent syphilis.

Latent syphilis Early latent syphilis ( infection onset 1 yr.) Late latent syphilis ( infection onset 1 yr. or unknown duration) 1/3 slowly progress to 3 syphilis The rest remain asymptomatic

Tertiary syphilis Late benign gummatous syphilis Cardiovascular syphilis Neurosyphilis

Serology 1. Nontreponemal tests : Use for screening and to follow therapeutic response - VDRL(Venereal disease research laboratory) - RPR (rapid plasma reagin) 2. Treponemal tests : Use to confirm reactive nontreponemal test result - FTA-ABS (Fluorescent treponemal antibody absorption) - TPHA (Treponema pallidum haemagglutination) - CIA (Chemiluminescence immunoassays)

Interpretation of Different Serological Tests in Syphilis Nontreponemal tests Treponemal tests Interpretation + + Syphilis - + Treated syphilis Late latent syphilis + - Biological false positive VDRL

VDRL/R PR FTA - ABS TPH A - + - + + + +/- + + 3 12 wk 4 12 wk Contact 3 wk. ( 10 90 d) Primary ( Chancre ) Secondary Early latent ( 1 yr from contact ) +/- + + Late latent ( 1 yr ) - + + Remission ( 2/3) Tertiary ( 1/3 )

Treatment Contact 3 wk. ( 10 90 d) Primary ( Chancre ) Early syphilis 3 12 wk Secondary 4 12 wk Early latent ( 1 yr from contact ) Late Syphilis Remission ( 2/3) Late latent ( 1 yr ) Tertiary ( 1/3 ) Benzathine penicillin G 2.4 million units

Treatment Contact 3 wk. ( 10 90 d) Primary ( Chancre ) Early syphilis 3 12 wk Secondary 4 12 wk Late Syphilis Remission ( 2/3) Early latent ( 1 yr from contact ) Late latent ( 1 yr ) Recommendations for treating syphilis in persons with HIV infection and pregnant women Tertiary ( 1/3 ) Benzathine penicillin G 2.4 million units

Jarisch-Herxheimer reaction Reaction is triggered by the toxins released when a large number of bacteria are killed after antibiotic treatment. Flu-like symptoms such as fever, headaches, muscle and joint pain. Occur within the first 24 hours after the initiation of any therapy for syphilis.

Follow up VDRL/RPR at 3, 6, 12, 24 m VDRL/RPR at 3, 6, 9, 12, 24 m (HIV)

Treatment failure Development of new clinical signs Four-fold increase in nontrepomenal test serology Failure of the nontrepomenal test serology to decrease 4-fold during 1 year in early syphilis 2 years in late syphilis

GONORRHEA

Male Genitalia

Female Genitalia Asymptomatic PID Leucorrhea (some)

Pharyngeal Gonorrhea Relatively common Asymptomatic Reservoir for infection

Rectal Gonorrhea It is a frequent site of infection in receptive anal intercourse.

Many rectal infections are asymptomatic. The symptoms of rectal gonococcal infection Minimal anal pruritus Painless mucopurulent discharge (often manifested only by a coating of stools with exudate) Scant rectal bleeding Proctitis (severe rectal pain, tenesmus, and constipation) proctitis

Gonorrhea conjuctivitis conjunctivitis

Cause : Neisseria gonorrhoeae Gram stain : Gram-Negative intracellular diplococci OR Culture : Neisseria gonorrhoeae positive

Uncomplicated urogenital, anorectal gonorrhea Ceftriaxone 250 mg IM Azithromycin 1 gm or Doxycycline(100)1*2 10-14 days Avoid sex at least for 1 week following treatment.

Complicated gonorrhea Ceftriaxone 250 mg IM Doxycycline(100)1*2 for 10-14 days at least 2 days

NON-GONOCOCCAL URETHRITIS

Male NGU

Female NGU Mucopurulent discharge

Proctitis and Conjunctivitis

Cause : Not Neisseria gonorrhoeae Other organism not gonorrhea - Chlamydia trachomatis (50%) - Ureaplasma urealyticum (10-40%) - Mycoplasma genitalium (15-20%) - Haemophilus vaginalis - etc.

INVESTIGATIONS Gram stain (urethral) : WBC 5 cells/oil field OR Mucopurulent discharge from cervix OR Culture : Chlamydia positive

Treatments Azithromycin 1 gm OR Doxycycline (100) 1*2 pc 14 d Avoid sex at least for 1 week following treatment.

Don t forget Sex partner(s) (60d) Avoid sex during treatment Avoid alcohol when take doxycycline Education Follow up